Magnetic sphincter augmentation is an effective option for refractory duodeno-gastro-oesophageal reflux following Billroth II gastrectomy

Abstract

Bile reflux into the gastric stump and then into the oesophagus is a common event after distal gastrectomy and Billroth II reconstruction. In addition to typical symptoms of nausea, epigastric pain and bile vomiting, acid reflux can also occur in patients with concomitant hiatus hernia and lower oesophageal sphincter incompetency. Diverting the bile away from the oesophagus by conversion into a Roux-en-Y anastomosis or by completion gastrectomy and Roux-en-Y esophagojejunostomy have so far represented the mainstay of treatment. We report the first case of magnetic sphincter augmentation to relieve refractory reflux symptoms after Billroth II gastrectomy. The procedure was performed through a laparoscopic approach and proved very effective at 1-year follow-up.

Systematic review of the introduction and evaluation of magnetic augmentation of the lower oesophageal sphincter for gastro-oesophageal reflux disease

“…). A total of 39 full‐text papers, published between 2008 and 2019, were finally included. The 39 articles consisted of one RCT, five comparative cohort studies (2 prospective and 3 retrospective), three comparative case–control studies, 25 case series (14 prospective, 11 retrospective) and five case reports ( Fig .…”

“…Twenty‐one followed the FDA eligibility criteria for MSA insertion. Seven, comprising a total of 427 patients and published after FDA approval, extended these criteria to include patients with a hiatus hernia greater than 3 cm or previous gastrointestinal surgery, to assess whether the device could be used in this population.…”

Magnetic Sphincter Augmentation After Gastric Surgery

“…One of these patients, Case 1 is included in the systematic review. 10 Demographic and clinical characteristics of patients who underwent MSA implant for primary (n = 63) or persistent/de novo (n = 4) GERD after gastric surgery during the same time period (October 2017 to December 2018) were compared. Patient characteristics and clinical outcomes were similar except for a statistically significant greater prevalence of grade-B esophagitis ( P = .014), operative time ( P = .000, CI = 67.6–87.9), size of MSA ( P = .046, CI = 14.8–15.2), and length of stay ( P = .038, CI = 2.3–2.7) in patients with prior gastric surgery ( Table 2 ).…”

“…As safety and efficacy of this technique became evident in clinical practice, indications for MSA have gradually expanded after Food & Drug Administration (FDA) approval in 2012 to include patients with large hiatal hernia, Barrett's esophagus, and severe symptoms/complications following previous gastric surgery. 6–10 Persistent or de novo GERD after gastric and bariatric surgery may be difficult to manage given the altered anatomy, unavailability of gastric fundus to perform a fundoplication, and the concern of morbidity associated to diversion procedures such as the Roux-en-Y gastric-bypass (RYGB). 11–12 Sleeve gastrectomy (SG) has now become the most common surgical procedure for obesity, with the percentage among bariatric operations increasing from 17.8% in 2011 to 53.8% in 2015.…”